摘要
目的:了解某三级甲等医院综合重症监护室(ICU)病人非计划重返的现状并分析其危险因素。方法:通过病例回顾选取2016—2019年某三级甲等医院内综合ICU转出的病人为研究对象,根据是否发生非计划重返,将其分为重返组和未重返组,采用单因素分析和二元Logistic回归分析筛选危险因素。结果:共纳入4542例病人,其中72 h内非计划重返ICU者92例,非计划重返ICU发生率为2.02%;其中24 h内和48 h内重返者共计74例,占重返人数的80.40%;非计划重返的主要原因为呼吸困难、血氧饱和度低;二元Logistic回归分析结果显示,付费方式(OR=2.109)、急性生理功能和慢性健康状况评分系统Ⅱ(APACHE-Ⅱ)评分(OR=1.069)、ICU住院时间(OR=1.033)和多器官功能障碍综合征(OR=2.332)是综合ICU病人72 h内非计划重返的危险因素(P<0.05)。结论:综合ICU转出病人以24 h和48 h内非计划重返者居多,付费方式、ICU住院时间、APACHE-Ⅱ评分和多器官功能障碍综合征是病人非计划重返ICU的独立危险因素,管理者应将非计划重返ICU发生率监测常态化,形成一个质量控制闭环,严格把握转出和转入ICU指征,积极应对可控因素,降低非计划重返ICU发生率。
Objective:To investigate the status and risk factors of unplanned readmission of patients in the comprehensive intensive care unit(ICU)in a third grade hospital.Methods:Patients who were transferred out of the comprehensive ICU in a third grade A hospital from 2016 to 2019 were selected as the study objects through case review.According to whether unplanned re-entry occurred,they were divided into the re-entry group and the non-re-entry group.Univariate analysis and binary Logistic regression analysis were used to screen risk factors.Results:A total of 4542 patients were included,including 92 patients who were unplanned to return to ICU within 72 hours,the incidence of unplanned readmission to ICU was 2.02%.Among them,74 cases returned within 24 hours and 48 hours,accounting for 80.40%of the total number of returners.The main causes of unplanned readmission were dyspnea and low oxygen saturation.Binary Logistic regression analysis results showed that,payment method(OR=2.109),Acute Physiology and Chronic Health Evaluation-Ⅱ(APACHE-Ⅱ)score(OR=1.069),length of stay in ICU(OR=1.033),and multiple organ dysfunction syndrome(OR=2.332)were risk factors for unplanned readmission within 72 hours in comprehensive ICU patients(P<0.05).Conclusions:The majority of patients who were transferred out of comprehensive ICU received unplanned readmission within 24 hours and 48 hours.Payment method,length of stay in ICU,APACHE-Ⅱscore and multiple organ dysfunction syndrome were independent risk factors for unplanned readmission to ICU.Managers should normalize monitoring of the incidence of unplanned readmission to ICU,form a quality control closed loop.Strictly grasp the indication of transfer out and transfer to ICU,actively deal with controllable factors,and reduce the incidence of unplanned readmission to ICU.
作者
刘子青
李桂芳
张桂珍
贾雪萍
王金聪
LIU Ziqing;LI Guifang;ZHANG Guizhen;JIA Xueping;WANG Jincong(School of Nursing,Ningxia Medical University,Ningxia 750000 China)
出处
《全科护理》
2023年第19期2598-2602,共5页
Chinese General Practice Nursing
关键词
非计划
重症监护室
危险因素
重返
unplanned
intensive care unit
risk factors
readmission
